Wearable continuous renal replacement therapy device

ABSTRACT

A continuous renal replacement therapy (CRRT) device adapted to be worn on a portion of the body of a patient. The CRRT device is worn by the patient and operates on rechargeable batteries for more than 5 hours dialysate is used to remove impurities from the blood. The dialysate is recycled and refreshed by a filter section. Less than one liter of dialysate is required to circulate through the wearable CRRT device.

REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 10/085,349, filed Nov. 16, 2001, which is hereby incorporatedby reference.

FIELD OF THE INVENTION

The present invention is directed to dialysis systems, and moreparticularly to a dialysis system that may be continuously worn by apatient.

BACKGROUND OF THE INVENTION

Hemodialysis is a process by which microscopic toxins are removed fromthe blood using a filtering membrane such as a dialyzer. Typically,hemodialysis is administered in intermittent three to four hourssessions, which take place two or three times per week. However, thereexists a growing body of research that prefers daily dialysis sinceincreased dialysis time improves outcomes both in terms of quality oflife and longevity. However, the implementation of daily dialysis isalmost impossible due to manpower and cost constraints. Furthermore,continuous renal replacement therapy (CRRT) over intermittent dialysissince far more toxins can be removed from the blood using CRRT sevendays a week, twenty-four hours a day. Some advantages of CRRT include anexpected decrease rate of morbidity and mortality, a decrease in theamount of medications required, a decrease in fluid intake and dietaryrestrictions, and numerous improvements in the quality of life of theESRD patients.

Existing CRRT machines are large, heavy machines adapted to providearound the clock dialysis, hemofiltration or a combination of both toindividual patients. The existing CRRT machines are cumbersome and mustbe hooked to electrical outlets and several feet of tubing. In addition,these machines require a continuous supply of gallons of fresh water tocreate dialysate fluid. Further, a patient must remain connected to theexisting heavy and cumbersome CRRT machine for many hours, limiting hisor her ability to perform normal every day activities.

An additional problem with existing dialysis machines, is that frequentreconnection to the machine requires accessing blood flow by puncturingan arteriovenous shunt. These shunts only last for limited periods oftime and are subject to infection, clotting and other complications thatresult in numerous hospitalizations and repeated surgical interventions.

Unsuccessful attempts have been made to create a wearable dialysisdevice. Because of the bulky nature of typical dialyzers and associatedsorbent devices, the concept of a wearable dialysis device has yet tobecome a reality for dialysis patients. In view of the abovedisadvantages, there continues to be a substantial need for a portable,wearable CRRT device, which can be used substantially continually, 24hours a day, seven days a week.

SUMMARY OF THE INVENTION

One embodiment of the present invention involves a wearable CRRT deviceadapted to be worn on a portion of the body of a patient, including atleast one or a plurality of dialyzers connected in series or parallelthat utilize dialysate to remove impurities from the blood of thepatient and at least one sorbent device for regenerating the spentdialysate.

Another embodiment of the present invention involves a wearable CRRTdevice adapted to be worn on a portion of the body of a patient,including at least one or a plurality of dialyzers, which comprise aplurality of cylindrical hollow fibers; wherein the patient's blood iscirculated within the hollow fibers in a first direction and wherein thedialysate is circulated around the exterior walls of the hollow fibersin a second, opposite direction; wherein the exterior walls of thehollow fibers are semiporous so that impurities can be moved from theblood and into the dialysate.

An additional embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including aplurality of dialyzers, which comprise a plurality of parallel sheets ofsemiporous material, wherein the patient's blood is circulated on oneside of the parallel sheets in a first direction and wherein thedialysate is circulated on the other side of the parallel sheets in asecond, opposite direction.

A further embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including aplurality of dialyzers; wherein the number of dialyzers in the pluralityof dialyzers may be varied to reflect different dialysis prescriptions;wherein at least one or each of the plurality of dialyzers has aflexible or semi-rigid casing adapted to conform to the body contour ofthe patient.

Yet another embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including aplurality of dialyzers having a blood inlet tube with a side port forthe infusion of additives; wherein the additives are pumped into theblood from a plurality of additive reservoirs and the rate of infusionof each additive is controlled electronically.

Another embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including atleast one dialyzer that utilizes dialysate to remove impurities from theblood of the patient and a plurality of sorbent devices connected inseries for regenerating the dialysate.

A further embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including aplurality of sorbent devices; wherein each of the sorbent devices has aflexible casing adapted to conform to the body contour of the patient.

An additional embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, including aseries of sorbent devices; wherein the series of sorbent devices is aseries of replaceable cartridges, which may include activated charcoal,urease, zirconium phosphate, hydrous zirconium oxide and/or activatedcarbon.

A further embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient and include aplurality of dialyzers connected in parallel.

Yet another embodiment of the present invention involves a CRRT deviceadapted to be worn on a portion of the body of a patient, include aplurality of sorbent devices connected in parallel.

Further applicability of embodiments of the present invention willbecome apparent from a review of the detailed description andaccompanying drawings. It should be understood that the description andexamples, while indicating preferred embodiments of the presentinvention, are not intended to limit the scope of the invention, andvarious changes and modifications within the spirit and scope of theinvention will become apparent to those skilled in the art.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description given below, together with the accompanyingdrawings, which are given by way of illustration only, and are not to beconstrued as limiting the scope of the present invention. In thedrawings:

FIG. 1 is a perspective view of the wearable CRRT device worn around thewaist of a dialysis patient according to the present invention.

FIG. 2 is a front view of the wearable CRRT device of FIG. 1 after beingdetached from the dialysis patient.

FIG. 3 is a perspective view of the dialyzer section of the wearableCRRT device according to the present invention.

FIG. 4 is a perspective view of the additive pump and dialyzer sectionsof the wearable CRRT device according to the present invention.

FIG. 5 is a cross-sectional view of a first embodiment of a dialyzer ofthe wearable CRRT device according to the present invention.

FIG. 6 is a cross-sectional view of a second embodiment of a dialyzer ofthe wearable CRRT device according to the present invention.

FIG. 7 is a top view of a casing of a dialyzer of the wearable CRRTdevice according to the present invention.

FIG. 8 is a perspective view of a first embodiment of the sorbentsection of the wearable CRRT device according to the present invention.

FIG. 9 is a perspective view of a second embodiment of the sorbentsection of the wearable CRRT device according to the present invention.

FIG. 10 is a perspective view of a variation of the second embodiment ofthe sorbent section of the wearable CRRT device according to the presentinvention.

FIG. 11 is a top view of a casing of a sorbent device of the wearableCRRT device according to the present invention.

FIG. 12 is a diagram of an exemplary embodiment of the wearable CRRTdevice.

FIGS. 13A-13H are charts indicating experimental results using anembodiment of the wearable CRRT device.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIGS. 1 and 2, a continuous renal replacement therapy(CRRT) device 10 is adapted to be worn about a portion of the body of adialysis patient 15. The CRRT device 10 includes a belt 20 that isdivided into a number of sections comprising: a dialyzer section 30including a blood inlet tube 33 leading from a blood vessel and a bloodoutlet tube leading to a blood vessel; a sorbent section 40; an additivepump section 50; and an electronic control section 60, which includes amicroprocessor and batteries to power device 10.

As best seen in FIG. 2, the belt 20 includes a pair of end portions 70,75, which are secured together by a conventional belt fastener 80 suchas a buckle, snaps, buttons or hook and loop fasteners. Although theCRRT device 10 depicted in FIG. 1 is worn about the waist of the patient15, it should be understood to those of ordinary skill in the art thatthe device 10 may, alternatively, be worn about other portions of thepatient's body, such as over a shoulder of the patient, for example.

Referring to FIG. 3, the dialyzer section 30 of the belt 20 includes aplurality of miniaturized dialyzers 100, 110, 120, 130 that utilizedialysate fluid 140 to remove impurities from the blood 150 of thepatient 15. The number of dialyzers 100, 110, 120, 130 in the pluralityof dialyzers 100, 110, 120, 130 may be varied to reflect differentdialysis prescriptions. As best seen in FIG. 3, the plurality ofdialyzers 100, 110, 120, 130 are connected in series, whereby aconventional pump forces the patient's blood 150 through a blood inlettube 33, through the dialyzers 100, 110, 120, 130 and into blood outlettube 37. It should be understood to those of ordinary skill in the artthat the dialyzers 100, 110, 120, 130 could also be connected inparallel without departing from the scope of the invention.

During dialysis, the dialysate is pumped in the opposite direction ofthe blood flow using a conventional pump (not shown) as indicated byarrows 125, 135, 145. Spent dialysate 140 flows toward sorbent section40 through spent dialysate tube 370. Excess fluid is removed from thespent dialysate 140 through a volumetric 155 and into a waste receiver65, which is to be periodically emptied by the patient via tap 175. Amicroprocessor in the electronic section 60 determines the rate andamount of fluid removal through volumetric pump 155.

With further reference to FIG. 3, the blood inlet tube 33 includes aside port 180 through which anticoagulant is pumped into the blood byanticoagulant pump 190. Typical anticoagulants are infused into theblood 150 include, but are not limited to, heparin, prostacyclin, lowmolecular weight heparin, hirudin and sodium citrate. As best seen inFIG. 4, the blood outlet tube 37 includes a side port 200 for theinfusion of additives, which are forced into the blood 150 from aplurality of additive pumps 270, 280, 290, 300. Piston, suction, piezo,micro, or very small roller pumps can be employed for this purpose. Suchpumps may all be classified as micropumps. Each additive pump 270, 280,290, 300 forces a controlled amount of respective additive into theblood 150, wherein the rate of infusion of each additive is controlledelectronically by the microprocessor in the electronic control section60. In a known manner, a physician can use the electronic controlsection 60 to set the rate of infusion for each additive to correspondto a predetermined dose for each additive. Since the additives cannot bemixed together prior to infusion in the blood 150, they have separatecircuits 305. Typical additives include, but are not limited to, sodiumcitrate, calcium, potassium and sodium bicarbonate.

Referring to FIG. 5, in a first dialyzer embodiment, each dialyzer 100,110, 120, 130 is a conventional dialyzer comprising a plurality ofcylindrical hollow fibers 310 through which the blood 150 is circulated.As indicated by arrows 320, 330, the dialysate fluid 140 is circulatedaround exterior walls 350 of the hollow fibers 310 in a direction acrossthe blood flow inside the hollow fibers 310 as indicated by arrows 325,335. The exterior walls 350 of the hollow fibers 310 are semiporous sothat impurities can be moved from the blood 150 and into the dialysate140. Fresh dialysate 140 flows from the sorbent section 40 through adialysate inlet tube 360 and into the series of dialyzers 100, 110, 120,130. The spent dialysate 140 then flows out of the series of dialyzers100, 110, 120, 130, through a spent dialysate outlet tube 370 and intothe sorbent section 40. The dialysate inlet tube 360 includes a sideport 380 (shown in FIG. 3) for the infusion of additives, which can beforced into the blood 150 via the aforementioned additive pumps 270,280, 290, 300, whereby the rate of infusion is controlled electronicallyby the microprocessor in the electronic control section 60. Referring toFIG. 6, in second dialyzer embodiment, each dialyzer 100, 110, 120, 130comprises a plurality of parallel sheets 390 of semiporous material,wherein the dialysate fluid 140 is circulated on one side of theparallel sheets 390 and the blood 150 circulates in the direction on theother side of the parallel sheets 390.

Referring to FIG. 7, each dialyzer 100, 110, 120, 130 is a miniaturedialyzer having a flexible casing 400 adapted to conform to the bodycontour of the patient. In addition, the body-side wall 410 of eachcasing 400 is concave to further correspond to bodily curves of theuser. The casing 400 can, be made of any suitable material havingadequate flexibility for conformance to the portion of the body to whichit is applied. Suitable materials include, but are not limited to,polyurethane and poly vinyl chloride.

Referring to FIG. 8-10, in the sorbent section 40, as indicated by arrow415, spent dialysate 140 flows from the dialyzer section 30 throughspent dialysate tube 370 and into a plurality of sorbent devices 420,430, 440, 450, 460. As indicated by arrow 465, the regenerated dialysate140 then flows through tube 360 and back into the dialyzer section 30.Preferably, the sorbent devices 420, 430, 440, 450, 460 comprise aseries of sorbent cartridges 420, 430, 440, 450, 460 for regeneratingthe spent dialysate 140. By regenerating the dialysate with sorbentcartridges 420, 430, 440, 450, 460, the exemplary CRRT device 10requires only a small fraction of the amount of dialysate of asingle-pass hemodialysis device. Importantly, each sorbent cartridge420, 430, 440, 450, 460 is a miniaturized sorbent cartridge 420, 430,440, 450, 460 containing a distinct sorbent.

Referring to FIG. 8, in a first embodiment of the sorbent section 40,there are five sorbent cartridges 420, 430, 440, 450, 460 including anactivated charcoal cartridge 420, a urease cartridge 430, a zirconiumphosphate cartridge 440, a hydrous zirconium oxide cartridge 450 and anactivated carbon cartridge 460. Those of ordinary skill in the art willrecognize that these sorbents are similar to the sorbents employed bythe commercially available Recirculating Dialysis (REDY) System.However, in the REDY System, the sorbents are layers of a singlecartridge. By contrast, the sorbents of the present invention are eachpart of a distinct sorbent cartridge 420, 430, 440, 450, 460 such thateach cartridge 420, 430, 440, 450, 460 may, conveniently, be replacedand disposed of independently of the other cartridges 420, 430, 440,450, 460 if so desired. As one of ordinary skill in the art wouldunderstand, activated charcoal, urease, zirconium phosphate, hydrouszirconium oxide and activated carbon are not the only chemicals thatcould be used as sorbents in the present CRRT device 10. In fact, anynumber of additional or alternative sorbents could be employed withoutdeparting from the scope of the present invention.

Referring to FIGS. 9 and 10, in a second embodiment of the sorbentsection 40, there are a plurality of sorbent cartridges 500, 510, 520,530, wherein each cartridge 500, 510, 520, 530 includes a plurality ofsorbent layers 540, 550, 560, 570, 580: an activated charcoal layer 540,a urease layer 550, a zirconium phosphate layer 560, a hydrous zirconiumoxide layer 570 and an activated carbon layer 580. The cartridges 500,510, 520, 530 may be in series as depicted in FIG. 9 or may be inparallel as depicted in FIG. 10. In this embodiment, the number ofsorbent devices may be varied to correspond with different dialysisprescriptions.

Referring to FIG. 11, each cartridge 500, 510, 520, 530 is a miniaturecartridge having a flexible or curved casing 600 adapted to conform tothe body contour of the patient. In addition, the body-side wall 610 ofeach casing 600 is concave to further correspond to bodily curves. Thecasing 600 can be made of any suitable material having adequateflexibility for conformance to the portion of the body to which it isapplied. Suitable materials include, but are not limited to,polyurethane and poly vinyl chloride.

Referring to FIG. 12, another exemplary embodiment of a wearable CRRTdevice is depicted. The wearable CRRT device 700 is built into, or ispart of, a patient wearable strap, belt or other wearable apparatus 702.The belt 702 may include a pair of endportions 704, 708 that are adaptedto be secured together by a fastening means (not specifically shown).The endportion/fastening means 704, 708 could be any number of fasteningdevices suitable to secure the ends of the belt or strap together, butnot limited to snaps, button, buckles, clips, laces, hook and loops,zippers, clasps, etc. An embodiment of a CRRT device may be envisionedto be the shape of an ammunition or military style supply belt, it couldalso be the shape of a waist-pack. An exemplary wearable CRRT device 700is worn by a patient either over or under other clothing.

A microcontroller 714 is utilized to control and monitor various aspectsof the wearable CRRT device 700. The microcontroller 714 is preferably alow or very low power microcontroller, but may be substantially anymicrocontroller adapted to operate in an exemplary wearable CRRT device700. One of the many functions of the microcontroller 714 has is tomonitor the battery 716. An exemplary CRRT device 700 will operatecontinuously for at least 5 to 10 hours using less than 10 continuouswatts of power. And preferably less than 3 continuous watts of power.Embodiments of the invention weight less than 10 lbs and preferably lessthan 5 lbs when operating.

The battery 716 is removably installed in the wearable CRRT device 700.The battery 716 is rechargeable and may be recharged while remaining inthe wearable CRRT device 700 via a charging device (not shown) or whendisconnected from the wearable CRRT device 700. Preferably the battery716 can store enough energy to power a wearable CRRT device 700 for atleast five (5) or more hours of continuous uninterrupted deviceoperation. The microcontroller, by itself, or via additional circuitry,monitors the charge status of the battery 716. If the microcontroller714 determines that the battery 716 is low on charge or has less than anestimated predetermined amount of operating time left (e.g., one hourleft), the microcontroller 714 may trigger an alarm condition via alarmcircuit 718. Alarm circuit 718 may provide any combination of an audio,visual, or physical alarm. The physical alarm signal may includevibrations or small tingle-style shocks to the patient. An alarmcondition or warning may be displayed on the display 720 using liquidcrystal, light emitting diode or other low power display technology. Analarm condition may also shut down all or predetermined parts of anexemplary wearable CRRT device 700.

A moisture sensor 722 is also in electrical communication with themicrocontroller 714. The moisture sensor 722 is used to detect highhumidity, condensation, or liquid present inside the packaging orcovering over (not specifically shown) the wearable CRRT device 700. Thepackaging or covering over an exemplary CRRT device 700 may be aplastic, cloth, rubberized, poly-product, or other suitable material.The covering may cover a portion of the wearable CRRT device 700 andallow access to various parts of the device such as the display 720 anduser/doctor controls 723.

High humidity, condensation or the presence of liquid inside a wearableCRRT device 700 may be indicative of patient blood leakage, dialysateleakage or other fluid leakage. Upon sensing moisture, the moisturesensor 722 provides a signal to the microcontroller 714 and an alarm istriggered via the alarm circuit 718. Furthermore, the pump 724 may beturned off by the microcontroller 714 to help minimize further blood,dialysate or other fluid loss. The microcontroller may shut down themicropumps (to be discussed later) also. The microcontroller 714 mayalso prompt an onboard communication device 725 to contact medical helpor another entity for medical assistance. The communication device maycomprise a paging wireless phone or other mobile communicationcircuitry. The communication device 725 may also be able to provide thegeographic location of the exemplary wearable CRRT device 700.

The pump 724 is an electric pump. The pump 724 may be two pumps 724 aand 724 b. The two pumps 724 a and 724 b may each operate off the sameor separate electric motors. The pumps 724 a and b are powered by therechargeable battery 716. Furthermore, the microcontroller 714 can beused to adjust various pumping variables. Potential adjustable pumpingvariables include, but are not limited to, adjusting the pump stroke,volume-per-stroke, speed, torque, pumping rate (i.e., number of pumpcycles per minute), pump pressure, pump pressure differential betweenthe input and output of the pump, and pump pause and cycle times.

An exemplary wearable CRRT device 700 has two fluid circuits: a bloodcircuit 727 and a dialysate circuit 729. A dual channel pulsatile pump724 may be used in an exemplary embodiment. A pulsatile pump, ingeneral, has a rubberized cartridge for each channel. A cartridge has aninput valve at an input side of the cartridge and an output valve at anoutput end of the cartridge. FIG. 12 depicts a single direction, dualpulsatile pump 724. A dual direction, dual pulsatile pump may also beutilized. A dual direction channel pump is preferred in order todecrease bending of the tubing used in the fluid circuits.

The motor and transmission within the pulsatile pump presses therubberized, tubular portion of the cartridge. The pressing of thecartridge squeezes and evacuates the contents of the cartridge out ofthe output valve. As the pump motor spins and causes the mechanics ofthe pump to release pressure from the rubberized portion of thecartridge, the output valve closes and the input valve opens to allowfluid (blood or dialysate) to enter the cartridge so that the fluid canbe squeezed out the output valve in the next pump cycle. The input andoutput valves are one-way valves allowing fluid flow in a singledirection through the cartridge. Other configurations of a pulsatilepump are also available. An exemplary pump 724 a, 724 b provides a bloodflow rate of between about 15 to 100 ml/min (pulsatile). The approximatedimensions of an exemplary dual-pulsatile pump 724 is 9.7×7.1×4.6 cmwith a weight of less than 400 grams. An exemplary pulsatile pump usesless than 10 watts of energy and may provide a low battery power and apump occlusion alarm signal to the microcontroller 714. A lower powerpulsatile pump using 5 or less watts may also be used.

The pulsatile pump can be tuned such that the pulses, or cycles, of thetwo pulse chambers are in phase, 180° out of phase or any predeterminednumber of degrees out of phase in order to utilize the pulses of thepump to aid in maximizing the dialysis process occurring in the dialyzer730. The opposite directional flows of blood and dialysate through thedialysate may become more efficient at different phase settings of thepumps 724 a and b.

Other types of pumps 724 can be successfully used or incorporated intoembodiments of the wearable ultrafiltration device. Two separate pumpsmay also be used. Such other types of pumps include, but are not limitedto, a shuttle pump, a piston pump, a roller pump, a centrifuge pump, apiezo electric pump, or other conventional pumps. Whatever pump isutilized, the pump(s) 724 should have a manually or electricallyadjustable flow rate ranging somewhere between 20 ml/min and 120 ml/min.

The microcontroller 714 may display pump status or other pump relatedinformation on the display 720. User controls 723, being buttons,switches, slide controls, knobs, connectors, or infrared receiver (notspecifically shown) may be used to enable a patient, physical, nurse,technician or computer based device to adjust various settings andcontrols on an exemplary ultrafiltration device 700. Furthermore, thecommunication device 725 may be utilized to receive control settings andsend information via paging or other telecom communication channels. Forexample, the adjustments to the pump 724 pump rate, torque, valveopening size, output pressure, flow rate, rpm, and on/off may all bemonitored or controlled via the user interface 723 or the communicationdevice 725.

Discussing the exemplary blood circuit 727 first, blood from the patiententers the blood circuit 727 via the blood inlet tube 726. An inputblood pressure transducer 728 measures the input blood pressure andprovides an input blood pressure signal to the microcontroller 714(connection to microcontroller not specifically shown). The input bloodpressure may be an average pressure of the blood prior to entering thepump 724 a. The blood is then pumped through the pump 724 a.

After the blood passes through the main pump 724 a, it continues in theblood circuit 727 via the blood inlet tube 726. An input blood pressuretransducer 728 measures the input blood pressure and provides an inputblood pressure signal to the microcontroller 714 (connection tomicrocontroller not specifically shown). The input blood pressure may bean average pressure of the blood prior to entering the pump 724 a. Theblood is then pumped through the pump 724 a.

After the blood passes through the main pump 724 a, it continues in theblood circuit 727. A reservoir 734 containing a blood thinner oranticoagulant such as heparin or another acceptable anticoagulantadditive is connected to the blood circuit via a micropump 736. Themicropump 736 provides the fluid contents of the reservoir 734, in ameasured continuous or non-continuous manner, to the blood circuit 727prior to the dialyzer 730. (It is possible to connect the reservoir734/pump 736 combination to the blood circuit before the pump 724 a.)The micropump 736 is a type of pump that can pump microscopic orminiscule amounts of fluid each minute. A micropump, in general, maypump fluid at a rate ranging from 0.1 to 400 ml/hr (milliliters perhour). A micropump requires from about 1 to 500 milliwatts to operate.There are, at present, various pumps that can be considered micropumpsincluding, but not limited to, a piezoelectric pump, a solenoid pump, amicro-piston pump, a peristaltic pump, a nanotechnology related pump,microtechnology/micromachined pump, syringe style pump, roller pump,centrifuge style pump, or diaphragm style pump.

The blood thinner and/or anticoagulant may be mixed or combined with theblood in the blood circuit at any point between the inlet of blood inlettube 726 and the blood input side of the dialyzer 730.

The reservoir 734 may have a fluid level sensor 735 or other type ofsensor to sense the amount of fluid available in the reservoir 734. Thesensor 735 provides a signal to the microcontroller 714 indicating anamount of fluid in the reservoir 734. The microcontroller 714 sends analarm signal to the alarm circuit 718 if the fluid level or fluid amountin the reservoir 734 is below a first predetermined amount or volume.The microcontroller 714 may also turn the ultrafiltration device 700 offif the fluid level in reservoir 734 is at the first predetermined levelor below the first predetermined level and at a second predeterminedlevel.

The combination of the reservoir 734 and the micropump 736 infuse theblood thinner or anticoagulant into the blood flowing in the bloodcircuit 727. Again, the thinner or anticoagulant is infused into theblood prior to the dialyzer (or blood filter) 730 (in some embodimentsprior to the blood pump 724 a) in order to help minimize the potentialof blood clots in the blood filter 730 and perhaps in the blood pump 724a.

A second pressure transducer 733 senses the pressure in the bloodcircuit after the blood pump 724 a, but before the dialyzer 730. Thepressure reading is supplied to the microcontroller (MC) 714 whichmonitors such readings.

A dialyzer 730, shown as a single dialyzer, can be a single or multipledialyzer as discussed earlier. The dialyzer(s) may take the form of acartridge that can be “clicked” or inserted into and out of theblood/dialysate circuits by a doctor, nurse or technician. The dialyzermay comprise from 0.2 to 1 sq. meters of dialyzing surface area. Duringdialysis the blood circuit 727 flows in the opposite direction as thedialysate circuit 729 in order to help maximize the dialysis process.Furthermore, the pulsing of the pumps 724 a and b may, either in phaseor out of phase, also aid in maximizing the dialysis processes.

The blood, after being dialyzed in the dialyzer 730, exits the dialyzer730 and flows through a third pressure transducer 737. The thirdpressure transducer 737 provides a pressure signal to themicrocontroller. The combination of the first, second and thirdtransducers provide differential pressure measurements that are analyzedby the microcontroller 714. For example, if the pressure differentialacross the dialyzer 730 is too high it may mean, among other things,that the dialyzer 730 has a clot in it or is being operated at too higha blood flow. As a result, an alarm situation can be initiated or theblood pump 724 a pumping rate or torque can be adjusted viamicroprocessor control. If the pressure at a transducer drops below apredetermined pressure it may be an indication of a fluid leak or thatair is in the blood circuit 727. The microcontroller 714 may shut downall or predetermine parts of the wearable CRRT device 700 in response topressure measured below a predetermined level.

The blood returns to the patient via the blood outlet tube 740. As shownin FIG. 4, a sideport 200 can be incorporated so that additionalelectrolytes, drugs, blood additives, vitamins or other fluids can beadded to the blood in the blood circuit 727 via a reservoir/micropumpcombination prior to the blood being returned to the patient via theblood outlet tube 740.

Referring still to FIG. 12, the exemplary dialysate circuit will now bediscussed. A fourth pressure transducer 750 measures the dialysatepressure at the input side of the dialysate pump 724 b and provides thepressure reading to the microcontroller 714. The dialysate pump 724 b,like the blood pump 724 a is preferably part of a dual pump device 724described above, but may be a separate pump device.

Cleaned, fresh dialysate from the sorbent filters 769 flows in thedialysate circuit 729 through the dialysate pump 724 b. The dialysatepump 724 b can pump dialysate at a flow rate ranging from near zero to150 ml/min. The exemplary normal operating flow rate of the dialysatepump is between 40 and 100 ml/min.

Embodiments of the wearable CRRT device 700 are designed to operateusing less than one liter of dialysate. Embodiments preferably onlyrequire 300 ml to 400 ml in the closed dialysate fluid circuit 729 tooperate. An embodiment designed for a young adult or child may operatewith about 100 to about 300 ml of dialysate. The combination ofdialysate and filters 769 allow an embodiment to circulate dialysate forat least 24 hours before a filter requires replacement. Furthermore,because less than a liter of dialysate is all that is needed in theclosed dialysate circuit 729, sterile or ultra-pure dialysate can beeconomically used in exemplary embodiments of the wearable CRRT device700.

In normal or large dialysis machines it is common to use about 90 litersof dialysate per patient per run. Generally, due to of the amount ofwater required to create the dialysate, filtered water, rather thanultra-pure water, is used. Filtered water is much less expensive thanultra-pure or sterile water. Filtered water that is used in dialysismachines is allowed to have some bacteria in it. The bacteria is largerthan the size of the pores in the membranes used in the dialyzer 730.Since the bacteria is larger than the pore size, the bacteria cannotcross the membrane and get into the blood.

Conversely, medical research has provided some results that areuncomfortable with the use of non-sterile dialysate (dialysatecontaining filtered water, bacteria, toxins, or micro organisms). Themicro organisms and bacteria create waste products, toxins or poisons inthe dialysate. The waste products from the bacteria can cross thedialyzer pores and get into the patient's blood while the actualbacteria cannot. Such toxins are referred to, in some cases, asendotoxins. The endotoxins that pass from the dialysate to the blood canhave a negative effect on the patient's health. The endotoxins can makethe patient sick.

Since exemplary embodiments of the wearable CRRT device 700 require lessthan one liter of dialysate it is economically feasible to useultra-pure or sterile water when making the dialysate.

The dialysate exits the dialysate pump 724 b, passes by another pressuretransducer 752, which measures the dialysate pressure on the input sideof dialyzer 730. The dialysate circuit 729 moves the dialysate into thedialyzer 730 such that the dialysate preferably moves in a directionopposite to the flow of blood through the dialyzer. While the dialysateis in the dialyzer to the dialysate 730, waste products and toxins inthe blood pass through the membranes of the dialyzer to the dialysatethereby cleaning the patient's blood.

The dialysate exits the dialyzer 730 and flows through another pressuretransducer 754. The pressure transducer 754 on the output side of thedialyzer 730 sends a signal to the microcontroller 714 indicating thepressure of the dialysate. The pressure may help indicate a cloggeddialyzer, a leak or other emergency condition.

The dialysate circuit 729 takes the used, toxin or contaminantcontaining, dialysate to the first of a series of dialysate filters 769.The filters may filter or react with predetermined substances in thedialysate in order to recycle the dialysate for continued use in thedialysate circuit.

In an exemplary embodiment, the first filter 760 contains urease. Theurease filters the used dialysate and further functions to break downurea that was removed from the blood in the dialyzer 730. When ureasebreaks down urea at least two unwanted bi-products are created.Generally, the two bi-products are ammonium (ammonia) and carbondioxide.

The dialysate with the ammonia and carbon dioxide exit the first filter760. The urea is substantially removed from the dialysate, but theammonia and carbon dioxide need to be removed from the dialysate also.The dialysate, ammonia, and carbon dioxide enter the second filter 762.The second filter 762 contains a compound containing zirconium orzirconium phosphate (i.e., ZrPx). The zirconium in the second filter 762captures the ammonia. It is understood by those having ordinary skill inthe art of dialysis chemistry that various chemicals and derivationsthereof can be utilized to achieve the same or similar results.

The zirconium filter, the second filter 762, will eventually becomesaturated with ammonia. The zirconium filter, when becoming saturatedwith ammonia, will become less efficient at removing ammonia from thedialysate. It is not advantageous to allow ammonia or ammonium tocirculate through the dialysate circuit 729. Thus, in an exemplarywearable CRRT 700, a sensor 764 is placed in the dialysate circuit 729to sense a presence of ammonia in the dialysate. The sensor 764 may be aph sensor, an ammonia specific sensor, or a conductivity sensor. If anammonia sensor is used it will sense whether a predetermined amount ofammonia is present in the dialysate. If a ph sensor is used, it wouldsense whether the ph of the dialysate has become a predetermined amountmore alkaline than normal. When ammonia is present, the dialysatebecomes more alkaline. It is noted that depending on the actualchemicals and absorbents used in the filters, the dialysate may becomemore acidic and as such a sensor would be used to sense the same. If aconductivity sensor is used, it will sense the conductivity changes ofthe dialysate.

The sensor 764 is in electrical communication with the microcontroller714. If the signal read by or provided to the microcontroller 714 fromthe sensor 764 indicates that the second filter 762, the zirconiumfilter, is not adsorbing a majority or a predetermined amount of theammonia in the dialysate, then an alarm condition is triggered by themicrocontroller 714. The alarm condition would instruct the user thatone or more filters (cartridges) need to be replaced. The alarmcondition may also shut down predetermined functions of the wearableCRRT device 700. For example, one or more pumps 724 may be shut down orthe pump rate of one or more pumps and micro pumps may be slowed.Slowing the pump rate may increase the amount of ammonia adsorbed by thezirconium based filters in the sorbent filter section 769.

The senor 764 that is used to sense the presence of ammonia in thedialysate is placed after the second filter 762 containing the zirconiumphosphate. The sensor 764 may be placed after the third filter 766, thatcontains hydrous zirconium oxide or the fourth filter 768 which is acarbon filter. One or more sensors in the dialysate circuit will sensepressure, pH, ammonia, flow rate, temperature or other physicalattributes. A sensor will provide a signal to the microcontrollerindicating that the dialysate circuit needs maintenance.

The third exemplary filter 766 is a hydrous zirconium oxide (ZrOx)filter which may further remove contaminants and ammonia from thedialysate. A bubbler degasser, or valve device 770 may be part of afilter (i.e., 762, 766 or 768) or be a separate element, as shown,removes air, carbon dioxide and other gas bubbles from the dialysate. Itis important that a limited amount of gas bubbles go through thedialyzer 730. As such a bubbler 770 (one or more) should be positionedprior to the pump 724b, but after the filter or filters that may causegas bubbles to form in the dialysate.

The fourth exemplary filter 768 contains carbon and is used to furtherclean the dialysate of impurities via adsorption. The filters, asdiscussed previously, are preferably designed as filter cartridges. Eachcartridge can be inserted and removed from the wearable CRRT device 700by the patient, doctor, technician or nurse. Each filter cartridge 760,762, 766, 768 may contain layers or combinations of chemicals oradsorbents. In fact, an exemplary embodiment may have a single cartridgefilter containing layers of required substances to clean and refresh thedialysate after passing through the dialyzer 730. The filtercartridge(s) may each incorporate a bubbler device or the bubbler 770may be a separate element in the dialysate circuit 729.

In an exemplary wearable CRRT device 700 the cartridge(s) may bereplaced daily or every other day by the patient. Each filter cartridgeshould weigh less than half a pound dry. The combination of all thecartridges, dry, should weigh less than two pounds total. Each filtercartridge may have inner dimensions of about 4 cm×10 cm×10 cm or providea volume of about 400 cm³±100 cm³ for each sorbent material. The totalvolume of all sorbent materials using in whatever quantity, combined,may be between about 400 cm³±2,000 cm³. In an exemplary embodiment afilter cartridge can be changed one a day or less often.

An additive reservoir 772 and micropump 774 may be connected to thedialysate circuit 729 after the filter cartridge(s) 769, but before thepump 724 b. Although not specifically shown in FIG. 12 multiplereservoirs 772 and micropumps 774 can be connected to the dialysatecircuit 729. The micropump(s) 774 may be any of the micropumps discussedabove with respect to micropump 736. Here the micropump(s) 774 andreservoirs 772 may add chemicals and additives to freshen the dialysateand prolong its ability to act as a dialysate. An exemplary wearableCRRT device 700 may have as little as 300 ml to about one liter ofdialysate in the dialysate circuit 729. It is important for the sorbentsection 769 to be able to clean and freshen the dialysate continuouslyas it circulates about the dialysate circuit 729.

An exemplary wearable CRRT device 700 may also remove ultrafiltrate orfluids from the patient's blood. The patient's kidneys may not befunctioning properly. After the dialysate leaves the dialyzer 730, andpreferably before the dialysate enters the filter cartridge(s) 769,ultrafiltrate/dialysate, along with other contaminants and fluidsobtained via the dialyzer 730, can be removed from the dialysate circuit729 via a valve 776 and deposited in a fluid bladder 778. The fluidbladder 778 may hang below the wearable CRRT device 700 (notspecifically shown) and be able to store from about 0.1 to 2 liters offluid. A fullness sensor associated with the fluid bladder 778 is inelectrical communication with the microcontroller 714 to enable an alarmcondition when the fluid bladder 778 at a predetermined fullness.

The fluid bladder 778 may also be incorporated into the wearable CRRTdevice 700 as an empty cartridge that is filled via a micropump andvalve combination 776. A fullness sensor 780 can aid the microcontrollerto determine the fullness of the cartridge bladder 776 will turn off theultrafiltrate supplying micropump 776 and provide a signal to the userthat the cartridge needs emptying. The fluid bladder or cartridge 778may contain an absorbent material (not specifically shown) for absorbingfluid presented to the bladder 778. The absorbent material may be acotton, polymer, sponge, compressed material, powder, jell or othermaterial that absorbs fluid and/or limits sloshing in the bladder orcartridge. The bladder may be designed to expand as it fills. Thebladder may press against a microswitch 780 (not specifically shown)when it is full thereby providing a signal to the microprocessor 714.

The fluid bladder or cartridge 778 may have a means for emptying thefluid bladder 782 thereon in the form of a cap, stopper, valve,removable inner bladder or otherwise.

Referring back to the blood circuit in FIG. 12, reservoir/micropumpcombinations 784 (piezo pumps, solenoid pumps, syringe pumps, etc.) canbe connected to the output side of the blood circuit dialyzer 730, 727.One or more micropumps and fluid reservoirs 784 can be connected.Additional heparin, electrolytes, blood additives, drugs, vitamins orhormones can be added to the dialyzed blood returning to the patient'sbody. The reservoir/micropump combinations are monitored and controlledby the microcontroller and can be adjusted via the user controls 723, orinstructions received via the communication device 725.

Exemplary embodiments of the wearable CRT device can provide therapyfrom a basic dialysis function to a more complex medical dialysis,ultrafiltration, and medicinal therapy to a patient.

As discussed, there continues to be a growing body of literatureindicating that increasing dialysis time, being longer or more frequentdialysis treatments, may be associated with improved outcomes in thetreatment of End Stage Renal Disease (ESRD) patients, both in terms oflife quality as well as expected morbidity and mortality.

However, the implementation of such modalities of treatment iscomplicated because of the lack of readily available economic resourcesto pay for the increased time or more frequent dialysis treatments.Furthermore, even if the money to pay for more dialysis time ortreatments was available, there is currently limited additional nursingor technician manpower to deliver much more additional care. Inaddition, construction of additional facilities would be necessary toaccommodate all these additional needs. Given the budgetary constrainsof health care budgets in most countries, the chances of any or all ofthese things occurring is slim. Furthermore, very few dialysis patientsare suitable for home self-treatment on non-wearable dialysis devices.

Embodiments of the wearable CRRT device are generally worn on a belt orstrap by the patient and can be used for continuous renal replacementtherapy twenty-four hours a day, seven days a week. Such embodiments candeliver significantly higher doses of dialysis than the intermittentdosing commonly administered by dialysis facilities today, while at thesame time achieving significant reductions in manpower utilization andother medical related costs.

Recently an embodiment of the invention was tested to assess theefficiency and viability of the inventions in a uremic pig model. Theefficiency of the exemplary wearable CRRT device was evaluated byachieving the removal of urea, creatinine, potassium, phosphorus andultrafiltrate in amounts that would normalize the volume status as wellas the above chemistries in uremic humans if the device would be worncontinuously. Furthermore, the efficiency of the device was tested byachieving dialysis doses that would be equal to or higher than thoseafforded by intermittent daily dialysis, as measured by creatinineclearance, urea clearance and weekly urea Kt/V.

The exemplary embodiment of the wearable CRRT device used in the testcomprised a blood circuit and a dialysate circuit. The blood circuit anddialysate circuit flowed through a small dialyzer that utilizedpolysulfone hollow fibers. The dialyzing surface area of the dialyzerwas about 0.2 meters. The blood circuit had a port for the continuousadministration of heparin into the circuit prior to the dialyzer. Boththe blood and dialysate were propelled through their requisite circuitsvia a double channel pulsatile pump powered by replaceable batteries.The dirty or spent dialysate that exited the dialyzer was circulatedthrough a series of filter cartridges containing urease and sorbentssimilar to those described by Marantz and coworker and widely used inthe well known REDY system. Ultrafiltrate was removed by the dialysatecircuit via a valving structure. The removed ultrafiltrate was directedto and stored in a plastic bag that was periodically emptied aftervolume measurement. Sensors connected to a micropressure monitoredvarious aspects of the exemplary device.

Six farm raised pigs each weighing approximately 150 lbs. wereanesthetized and made uremic by surgical ligation of both ureters.Twenty-four to forty-eight hours later the animals were againanesthetized and a double lumen Mahurkar catheter was inserted in ajugular vein. The catheter was connected to the exemplary CRRT deviceand each animal was dialyzed for eight hours. At the end of the eighthours the animals were euphemized.

Blood samples were drawn from an arterial line inserted in the carotidartery and CBC, urea, creatinine, sodium, potassium, chloride, CO₂,phosphorus, calcium and magnesium were measured. The same chemistrieswere measured in the dialysate circuit at the input side of the dialyzerand at the exit side of each filter cartridge.

The results of the test experiment were as follows. There were noadverse events observed in the animals during the test experiments. Theaverage blood flow rate in the blood circuit was 44 ml/min and theaverage dialysate flow rate was 73 ml/min. The results of the testexperiments are summarized in Tables I and II. TABLE 1 Amount of FluidRemoved (in ml.) from each Animal in Eight Hours Pig C Pig D Pig E Pig FPig G Pig H (g) (g) (g) (g) (g) (g) 1 hr. 400 100 100 100 150 180 2 hrs700 200 200 200 220 200 3 hrs 300 200 300 380 350 4 hrs 800 400 250 400500 700 5 hrs 500 300 500 600 710 6 hrs 500 500 800 690 1410 7 hrs 620600 1000 700 1400 8 hrs 800 1000 1150 800 1400 Average 100 100 124 144100 175

TABLE II Experimental Data Acquired from Six Pigs, Using the ExemplaryCRRT Device Total Creatinine Total Urea Weekly Creatinine Removed UreaRemoved std Phosphorus Potassium Clearance (g) Clearance (g) (Kt/V)(grams) (mmole) (mL/min) (8 hrs) (mL/min) (8 hrs) Urea (24 hrs) (24 hrs)Pig C 20.10 0.91 29.40 7.61 6.50 2.30 266.11 Pig D 21.10 0.76 26.80 5.756.20 2.60 259.91 Pig E 23.50 1.14 27.30 5.37 6.10 2.67 303.54 Pig F23.50 1.14 27.30 5.37 6.00 2.44 270.50 Pig G 22.30 0.95 25.70 6.46 5.202.41 236.97 Pig H 22.30 1.02 26.30 6.24 5.80 2.42 227.01 Mean 22.13 ±1.34  0.99 ± 0.15 27.13 ± 1.27 6.13 ± 0.85 5.97 ± 0.44 2.47 ± 0.14260.67 ± 27.05 

The fluid volume removed was changed arbitrarily during the experimentfrom 0 to about 700 ml/hr. The limiting factor for the removal of largeramounts of fluid per hour was a progressive decrease in blood flow inthe dialyzer as the rate of fluid removal was increased. The blood flownormalized immediately as the rate of ultrafiltration (fluid removal)was decreased. There were no difficulties however in maintaining a fluidremoval of 100 ml/hr. The amounts of urea, creatinine, potassium andphosphorus are further shown in FIGS. 13A through 13H. The amounts ofpotassium and phosphorous removed are expressed per twenty-four hours oftreatment. The daily removal of potassium was 260.67±27.05 mmol/24 hrs.The daily removal of phosphorus was 2.47±0.14 gr/24 hours. The averagecreatinine clearance obtained with this exemplary embodiment was22.13±1.34 ml/min. The average urea clearance was 27.13±1.27 ml/min andthe weekly urea Kt/V was 5.97±0.44.

The lack of complications in the test experiments implies that theexemplary wearable CRRT device may be operated with the potential of nocomplications. The exemplary experimental wearable CRRT device has notdisplayed any complications differing from complications associated withexisting large scale dialysis machines presently in use in the industry.The relatively low flow rates of the blood circuit and dialysate circuithelp mitigate various complications found in some dialysis systems.Modifications can be made to the experimental exemplary CRRT device toallow an increase in the blood flow to range from about 50 to 120ml/min. The modifications include at least one of increasing the size ofthe dialyzer, increasing the flow of the dual pump, and adjusting thetransmission, gearing and valving of the pump.

The capacity of an exemplary wearable CRRT device to remove fluidsteadily from the vascular space in amounts similar to the volume offluids removed physiologically by normal kidney gives a treatingphysician the ability to keep a patient euvolemic, regardless of theamount of fluid the patient ingests. Further, the elimination of excessfluid may also result in better control of a patient's hypertension. Thesodium concentration in the extracted ultrafiltrate is roughly equal tothe sodium concentration of the patient's plasma. Thus, removal of about0.5 to 3 liters of ultrafiltrate, via an exemplary CRRT device, a daywill result in removal of about 10 to 20 grams of salt per day. Removalof sodium from a patient via an embodiment of the invention maycontribute to better control of a patient's hypertension, and alsoresult in liberalizing salt intake for ESRD patients. Thereby, perhapsimproving a patient's quality of life by increasing the variety of foodsa patient can eat. Furthermore, eating a variety of foods may result inimproved nutrition for the patient.

Also, the amounts of potassium and phosphorus removed from a patient'sblood by an exemplary wearable CRRT device further helps eliminaterestrictions on oral intake of both the elements, and the elimination ofa need for oral phosphate binders.

The experimental results indicate that the amount of creatinine and urearemoved, as well as the high dialysis dose, expressed in both clearancesand weekly urea Kt/V would make it feasible to achieve all the benefitsof presently provided intermittent daily dialysis doses. The experiment,at the same time, proved a potential for decreasing the use of medicalmanpower and other costs associated with chronic dialysis.

Many variations and embodiments of the above-described invention arepossible. Although only certain embodiments of the invention have beenillustrated in the accompanying drawings and described in the foregoingDetailed Description, it will be understood that the invention is notlimited to the embodiments disclosed, but is capable of additionalrearrangements, modifications and substitutions without departing fromthe invention as set forth and defined by the following claims.Accordingly, it should be understood that the scope of the presentinvention encompasses all such arrangements and is solely limited by theclaims as follows:

1. A continuous renal replacement therapy (CRRT) device comprising:means for enabling a patient to wear the entire CRRT device; amicrocontroller, said microcontroller adapted to be powered by abattery; a pump, controlled by said microcontroller, said pumpcomprising a first pump and a second pump, said pump adapted to bepowered by said battery; a blood circuit comprising: a blood inlet tubefor receiving blood from a patient; said first pump for pumping bloodthrough said blood circuit; a first micropump for pumping ananticoagulant into said blood circuit, said micro pump being controlledby said microcontroller; a dialyzer receiving blood pumped by said firstpump; a pressure transducer for providing a blood circuit pressuresignal to said microcontroller; an outlet port for allowing blood to goback into said patient after being received by said dialyzer; and adialysate circuit for circulating dialysate through said dialyzer andfor removing contaminants from said circulating dialysate, saiddialysate circuit comprising: a filter section for reacting withpredetermined substances in said dialysate in order to recycle saiddialysate for continued usage in said dialysate circuit; said secondpump for pumping dialysate through said dialysate circuit; a sensor,attached to said dialysate circuit, providing a signal to saidmicroprocessor indicating that at said filter section requiresmaintenance; a degasser, attached to said dialysate circuit, forremoving gas from said dialysate circuit; and said CRRT device beingadapted to operate on less than 10 watts of power.
 2. The CRRT device ofclaim 1, wherein said CRRT device being adapted to operate on less than3 watts of power.
 3. The CRRT device of claim 1, wherein said batterycan power said CRRT device for more than six continuous hours.
 4. TheCRRT device of claim 1, further comprising a moisture sensor forproviding a signal to said microcontroller indicating that said moisturesensor is sensing moisture in said CRRT device.
 5. The CRRT device ofclaim 4, wherein said microcontroller initiates an alarm condition uponan indication that said moisture sensor is sensing moisture in said CRRTdevice.
 6. The CRRT device of claim 1, further comprising a wirelesscommunication device in electrical communication with saidmicrocontroller, said communication device adapted to communicatewirelessly with a medical facility.
 7. The CRRT device of claim 1,wherein said pump is a pulsatile pump.
 8. The CRRT device of claim 1,wherein said first pump and said second pump, of said pump, pump inopposing directions.
 9. The CRRT device of claim 1, wherein said firstpump can pump blood at a variably controlled rate between zero to about100 ml/min.
 10. The CRRT device of claim 1, wherein said first pump canpump blood at a variably controlled rate between zero to about 80ml/min.
 11. The CRRT device of claim 7, wherein said first pump and saidsecond pump each pump a predetermined number of degrees out of phase.12. The CRRT device of claim 1, wherein said CRRT device is adapted toweigh less than about 5 pounds when operating.
 13. The CRRT device ofclaim 1, wherein said pump provides an occlusion signal to saidmicrocontroller.
 14. The CRRT device of claim 1, wherein said bloodcircuit further comprises an additional micropump for adding at leastone of electrolytes, blood additives, drugs, vitamins and hormones tosaid blood prior to said blood returning to said patient.
 15. The CRRTdevice of claim 1, wherein said micropump is adapted to pump a fluid ata rate between 0.1 and 400 ml/hr.
 16. The CRRT device of claim 1,wherein said first micropump requires between 1 and 500 milli watts tooperate.
 17. The CRRT device of claim 1, further comprising ananticoagulant reservoir in fluid communication with said first micropumpand a fluid sensor associated with said anticoagulant reservoir, saidfluid sensor providing a signal to said microcontroller when a volume ofanticoagulant in said anticoagulant reservoir is below a predeterminedvolume.
 18. The CRRT device of claim 1, wherein said filter sectioncomprises at least one filter and wherein said at least one filter isadapted to be inserted and removed from said dialysate circuit as adisposable cartridge.
 19. The CRRT device of claim 1, wherein saidsecond pump is adapted to variably pump said dialysate at a flow ratebetween zero and 150 ml/min.
 20. The CRRT device of claim 1, whereinsaid second pump is adapted to variably pump said dialysate at a flowrate between zero and 100 ml/min.
 21. The CRRT device of claim 1,wherein said CRRT device is adapted to operate with less than 400 ml ofdialysate.
 22. The CRRT device of claim 1, wherein said CRRT device isadapted to operate with between 100 and 300 ml of dialysate.
 23. TheCRRT device of claim 1, wherein said dialysate comprises ultra-puredialysate.
 24. The CRRT device of claim 1, wherein said CRRT device isadapted to circulate less than about 1 liter of dialysate.
 25. The CRRTdevice of claim 1, wherein said dialyzer comprises less than 0.5 metersof dialyzing surface area.
 26. The CRRT device of claim 1, wherein saidfilter section comprises a plurality of filter cartridges.
 27. The CRRTdevice of claim 1, wherein said sensor senses a pH of said dialysate.28. The CRRT device of claim 1, wherein said sensor senses a presence ofa predetermined substance in said dialysate.
 29. The CRRT device ofclaim 28, wherein said predetermined substance is ammonia.
 30. The CRRTdevice of claim 1, wherein said degasser is an integral part of saidfilter section.
 31. The CRRT device of claim 30, wherein said filtersection comprises at least one filter cartridge and said degasser is anintegral part of at least one filter cartridge.
 32. A wearableContinuous Renal Replacement Therapy (CRRT) device comprising: adialyzer; a blood circuit for moving blood from a patient through saiddialyzer and back to said patient; a dialysate circuit for circulatingdialysate through said dialyzer and for refreshing said dialysate; amicrocontroller for controlling the movement of blood and dialysatethrough said blood circuit and said dialysate circuit respectfully; acovering substantially covering said wearable CRRT device; means forenabling a patient to wear said wearable CRRT device attached to saidcovering; a moisture sensor, inside said covering for sensing moisture,said moisture sensor providing a moisture signal to saidmicrocontroller.
 33. A wearable Continuous Renal Replacement Therapy(CRRT) device comprising: a dialyzer; a blood circuit for moving bloodfrom a patient through said dialyzer and back to said patient; adialysate circuit for circulating dialysate through said dialyzer and afor refreshing said dialysate; a microcontroller for controlling themovement of blood and dialysate through said blood circuit and saiddialysate circuit respectfully; a covering substantially covering saidwearable CRRT device; said wearable CRRT device adapted to operate onless than 10 watts of power.
 34. The wearable CRRT device of claim 33,adapted to operate on less than 5 watts of power.
 35. The wearable CRRTdevice of claim 33, adapted to electrically connect to and hold arechargeable battery, said rechargeable battery adapted to provide atleast 5 hours of continuous power to said wearable CRRT device.
 36. Thewearable CRRT device of claim 33, further comprising a dual pump, saiddual pump comprising a first pump for pumping blood in the blood circuitand a second pump for pumping dialysate in said dialysate circuit, saidfirst pump and said second pump being mechanically powered by the samemotor.
 37. The wearable CRRT device of claim 33, further comprising adual pump, said dual pump comprising a first pump for pumping blood inthe blood circuit and a second pump for pumping dialysate in thedialysate circuit.
 38. The wearable CRRT device of claim 33, furthercomprising a first pump for pumping blood through said blood circuit anda second pump for pumping dialysate through said dialysate circuit. 39.The wearable CRRT device of claim 33, further comprising at least onepulsatile pump for pumping at least one of blood and said dialysate. 40.The wearable CRRT device of claim 33, wherein said dialysate circuit isadapted to circulate and refresh said dialysate for at least 24 hourswithout requiring said dialysate to be replaced.
 41. The wearable CRRTdevice of claim 33, further at least one filter in said dialysatecircuit for refreshing said dialysate.
 42. The wearable CRRT device ofclaim 41, further comprising a dialysate sensor for sensing a physicalattribute of said dialysate, said physical attribute being indicative ofwhether at least one filter has decreased efficiency.
 43. The wearableCRRT device of claim 42, wherein said dialysate sensor senses for atleast one of pH and ammonia.
 44. The wearable CRRT device of claim 33,wherein said dialyzer comprises less than about 0.5 meters of dialyzingsurface area.
 45. The wearable CRRT device of claim 33, wherein saidmicrocontroller further provides an alarm condition wherein the patientis informed of an alarm condition.
 46. The wearable CRRT device of claim45, wherein said microcontroller turns off predetermined parts of saidwearable CRRT device in the event of an alarm condition.
 47. Thewearable CRRT device of claim 33, wherein said dialysate circuitcomprises filter cartridges that are removable and replaceable by thepatient.
 48. The wearable CRRT device of claim 33, further comprising amicropump for adding dialysate additives to said dialysate circuit, saidmicropump adapted to add an additive at a rate of 0.1 to 400 ml perhour.
 49. The wearable CRRT device of claim 33, further comprising: afluid valve connected to said dialysate circuit for extracting fluidfrom said dialysate circuit; and a bladder, in fluid connection withsaid fluid valve, said microcontroller adapted to control said fluidvalve, said microcontroller adapted to receive a signal from saidbladder indicative of the fullness of said bladder.
 50. The wearableCRRT device of claim 33 further comprising a gas valve for removingbubbles or gas from said dialysate circuit.